Adolescent Vaccination in the Medical Home

描述（由申请人提供）：该项目的总体目标是提高国家在初级保健实践（医疗机构）中为青少年接种疫苗的能力。大多数青少年都有一个医疗之家，先前的研究表明，需要加强医疗之家，以有效地为青少年接种疫苗。该项目将确定并严格评价一项可行和可持续的战略，以改进在医疗所内的青少年疫苗接种。我们将与两个以初级保健实践为基础的研究网络（pbrn）合作——一个区域网络（85个实践）和一个以学术为基础的国家医疗之家网络（110个实践），以评估多成分青少年疫苗接种战略。这一战略将在各种各样的医疗机构中进行评估，这些医疗机构因专业（儿科、家庭医学）、患者群体（高收入和低收入）、执业类型（私人、诊所、保健中心）和教学角色（有住院医生和没有住院医生的执业）而异。其目的是：1。对网络中所有做法的从业人员进行形成性定量调查，并对从业人员和家长进行定性访谈，以确定可行和可持续的青少年疫苗接种战略。我们将使用改进的德尔菲法来选择最优的策略进行评估；2. 设计并实施一项随机对照试验，在每个PBRN中采用6种干预做法和6种标准护理对照做法（n=24种做法）。我们将使用标准化的图表审查（n= 3840名青少年，每次执业160人）来衡量基线免疫率、错过的机会、预防性就诊和其他就诊。我们将实施多元策略；并在18个月的随访中评估相同的指标。我们将使用双变量和多变量分析来评估该策略对整个人群、患者亚组和实践类型的关键措施的影响；3. 通过评估《青少年预防服务指南》提供的预防性访问和服务，在1800万干预之前和之后，评估该战略对获得预防性服务的影响；4. 评估成本和成本效益，以及战略的可行性，使用人员/非人员资源的标准化评估和对医生的调查来衡量看法；5. 与顾问和国家组织（AAP， AAFP， APA， SAM， CDC）合作，传播研究结果；为医疗之家制定工具包，以实施青少年疫苗接种的最佳战略。我们的团队一直处于儿童、成人和现在的青少年免疫接种研究的前沿。我们在涉及医疗之家的干预以及资源和成本分析方面有着长期的经验。通过在广泛的患者和实践中严格评估可行的基于实践的战略的有效性，本研究将为免疫和公共卫生的从业者和领导者提供关键信息，以实施加强青少年免疫和预防保健的战略。

DESCRIPTION (provided by applicant): The overall goal of this project is to enhance the nation's ability to vaccinate adolescents in primary care practices (medical homes). Most adolescents have a medical home, and prior studies demonstrate that enhancements are needed in medical homes to efficiently vaccinate adolescents. The project will identify and rigorously evaluate a feasible and sustainable strategy for improving adolescent vaccinations within medical homes. We will work with two primary care practice-based research networks (PBRNs)-a regional network (85 practices) and a national network of academic-based medical homes (110 practices), to evaluate a multi-component adolescent vaccination strategy. This strategy will be evaluated in a diverse spectrum of medical homes that vary by specialty (pediatrics, family medicine), patient population (high and lower income), practice type (private, clinic, health center), and teaching role (practices with and without residents). The aims are to: 1. Perform formative quantitative surveys of practitioners from all practices in the networks and qualitative interviews of practitioners and parents to identify feasible and sustainable adolescent vaccination strategies. We will use a modified Delphi technique to select the most optimal strategy to evaluate; 2. Design and implement a randomized controlled trial, with 6 intervention practices and 6 standard-of-care control practices within each PBRN (n=24 practices). We will use standardized chart reviews (n=3,840 adolescents, 160 per practice) to measure baseline rates of immunizations, missed opportunities, preventive visits, and other visits. We will implement a multi-component strategy; and asses the same measures at 18-month follow-up. We will use bivariate and multivariate analyses to assess the impact of the strategy on the key measures, for the entire population and for subgroups of patients and practice types; 3. Evaluate the impact of the strategy on receipt of preventive services by assessing preventive visits and services from the Guidelines for Adolescent Preventive Services, before and after the 18m intervention; 4. Evaluate costs and cost-effectiveness, as well as the feasibility of the strategy, using standardized assessments of personnel/non-personnel resources and surveys of physicians to gauge perceptions; 5. Work with consultants and national organizations (AAP, AAFP, APA, SAM, CDC) to disseminate findings; develop a toolkit for medical homes to implement best strategies for adolescent vaccinations. Our team has been at the forefront of research in childhood, adult, and now adolescent immunization delivery. We have longstanding experience in interventions involving medical homes, and analyses of resources and costs. By rigorously evaluating the effectiveness of a feasible practice-based strategy across a wide spectrum of patients and practices, this study will provide critical information for practitioners and leaders in immunization and public health to implement strategies to enhance adolescent immunizations and preventive care. PUBLIC HEALTH RELEVANCE: Due to the recent recommendation of three new adolescent vaccines (meningococcus, pertussis, and HPV vaccines) and two new vaccine recommendations for adolescents (influenza and varicella), adolescent vaccinations have become a major new priority area for public health. Currently, adolescent vaccination rates are low. Primary care practices or medical homes are the major sources of healthcare for the majority of adolescents across the US, yet evidence is needed for feasible and sustainable strategies, within medical homes, to optimize adolescent vaccination delivery. This study will provide critical information for pediatrics, adolescent medicine, and public health regarding practical strategies for vaccinating adolescents, the cost of these strategies, and the potential spillover benefits for improving other preventive services by enhancing vaccination of adolescents in medical homes.